Running on Empty: The Crisis in Asthma Control

There is also rampant “presenteeism” in the workplace, says Dr. Kenneth Chapman, the director of the Asthma and Airway Centre of the University Health Network in Toronto. This refers to asthmatics who show up to work but aren’t functioning at full capacity because they’re experiencing symptoms, or they were up all night wheezing and coughing.

Asthma “control” is defined by how often a person has symptoms. The Canadian Asthma Consensus Guidelines say that if a patient coughs, wheezes or has tightness in his chest three or more times a week, the asthma is out of control. If asthma keeps the person up at night once or more a week, that is unacceptable.

If asthma has made the person stop exercising once in the last three months, or he uses a reliever puffer more than three times per week, again, the asthma is out of control.

Poor asthma management begins where most asthma patients seek treatment: the family doctor’s office. Often, a physician will diagnose a patient after he or she complains of wheezing or shortness of breath. In many instances, spirometry, a lung-function test, is not done, and medication needs are estimated.

“They will say, ‘this is asthma’ based on the fact we’re wheezing and we have a cough, and here’s a treatment,” says Dr. Alan Kaplan, a doctor in Richmond Hill, Ont. who chairs the Family Physician Airways Group of Canada. “They just try therapy, rather than doing a definitive test.”

Also, the doctor isn’t always able to explain fully to the patient how the medications work, and what kind of results to expect. “Physicians obviously give good information to the patient, but are limited by the time and resources they have,” says Haffner of the Lung Association.

Because the patient doesn’t really know any better, the next time the doctor sees him and asks how his asthma is, he’ll invariably answer that ‘it’s fine.’

Studies show, and experts agree, that there is a great deal of patient confusion about asthma medication, primarily how it works and whether it’s safe. There are two types of medication to treat asthma: controller and reliever.

Controller medications, usually inhaled corticosteroids, are meant to be taken every day to prevent inflammation in the lungs. Reliever medications shouldn’t be needed on a regular basis, but will open the lungs in the event of an asthma flare-up.

All too often, patients don’t take their controller medication, the corticosteroid, at all. “They’re afraid of the steroid word,” says Kaplan. But corticosteroids aren’t like the muscle-building steroids that are known to harm your body.

And Boulet says any legitimate long-term side effects, such as loss of bone density, should not occur at the doses usually prescribed. (Canadian guidelines stress that doctors should prescribe the lowest dose necessary to control the condition.)

“Corticosteroids are extremely safe,” he says. Yet, according to the Asthma Society, more than a third of those prescribed an inhaled corticosteroid don’t have any intention of even filling the prescription. Another 20 per cent fill it, but don’t take the medicine.